Nigeria

Millions will be spared future suffering thanks to collaborative efforts of The Carter Center and Nigeria's Federal Ministry of Health to address widespread neglected diseases such as Guinea worm, lymphatic filariasis, schistosomiasis, river blindness, trachoma, and malaria. The Center also has assisted efforts to build democracy and peace in this, Africa's most populous nation.

Waging Peace

From its independence from Great Britain in 1960 until its historic presidential election in 1999, Nigeria was under military rule for all but 10 years. For three decades, the country suffered from unfettered corruption and ethnic violence. After the death of dictator Gen. l Sani Abacha in June 1998, Gen. Abdulsalami Abubakar rose to power and instituted democratic reforms. He legalized political parties, political prisoners were released, and the press operated unhindered. The Carter Center was invited to observe elections called for February 1999.

+Monitoring Elections

1999 Elections

After the death of dictator Gen. Sani Abacha in June 1998, Gen. Abdulsalami Abubakar rose to power and instituted democratic reforms. He legalized political parties, political prisoners were released, and the press operated unhindered. The Carter Center was invited to observe elections called for February 1999.

The Carter Center and its partner, the National Democratic Institute for International Affairs (NDI), observed voting on Feb. 20, 1999, for National Assembly members. Observers, led by former U.S. President Jimmy Carter, saw a low turnout and serious irregularities nationwide, including ballot stuffing, inflation of results, and voter intimidation.

President Carter was joined by retired U.S. Army Gen. Colin Powell and former Niger President Mahamane Ousmane to lead a 66-member delegation to observe the Feb. 27, 1999, presidential election. The Center and NDI again found serious irregularities. President Carter sent a letter to the election commission asserting the Center could not verify the outcome of the election because of the seriousness of the flaws observed. Nevertheless, former Gen. Olusegun Obasanjo was later sworn in as president.

2003 Presidential Election

The Center and NDI again called for significant changes in electoral preparations for the 2003 presidential election. After a pre-election mission in March 2003, NDI and the Center called on Nigeria's election commission to put the voter register out for public review, publicize the number of registered voters, inform citizens how to acquire a voter card, and simplify the process for accrediting election observers. In addition, the government was urged to establish a national security plan for the elections. Nigeria's pre-election period was marked by violence, including the assassination of candidates and political activists, and the Center did not observe the April 2003 election.

+Encouraging a Free Press

Because a free press is vital to a strong democracy, The Carter Center arranged professional training workshops in 1999 for print and broadcast reporters in Nigeria covering the elections and political issues. Workshops focused on such topics as story structure, the media's role in free and fair elections, and how to deal with censorship and government interference. The project was a collaborative effort of the U.S. Information Service's Democracy and Governance Program, the Nigerian nongovernmental organization Media Rights Agenda, The Carter Center, and the DeWitt Wallace Center at Duke University in North Carolina.

+Defending Human Rights

To promote peace and democracy, The Carter Center often speaks out against human rights violations. In November 1995, President Carter wrote to Nigeria Head of State Gen. Sani Abacha to express his "profound dismay and shock" at the execution of nine environmental and minority rights advocates, including Ken Saro-Wiwa. President Carter called on Gen. Abacha to "release all other prisoners detained or convicted on the basis of the peaceful expression of their beliefs, to commute the sentences of other detainees facing capital punishment on politically inspired grounds, and to give full effect to the rule of law in Nigeria."

A letter also was sent to the secretary-general of the Commonwealth of Nations stating that the executions raised "serious questions as to Nigeria's continued good standing with the international community."

+Resolving Conflict

President Carter visited the Niger River Delta in February 1999 to meet with activists, who had grown more confrontational in protesting policies and practices of the government and major oil companies operating in the area.

After meetings with Ijaw Youth Council representatives and elders from the Ijaw, Urhobo, Isoko, Ogoni, and Itsekiri peoples, President Carter recommended consideration of several options. They included initiating a dialogue with representatives chosen by the Delta people themselves and establishing a clearer federal oil revenue-sharing formula to allow local and state officials in the Delta region to administer oil revenues for new roads and other projects. He also suggested that a social development trust fund be administered privately with local participation to support more such projects.

Fighting Disease

Nigeria has one of the highest burdens of disease on the continent. In 1988, the government of Nigeria invited The Carter Center to begin Guinea worm eradication programming in the nation. Subsequently, The Carter Center established six more health programs in Nigeria.

+Eradicating Guinea Worm Disease

Current Status:Transmission stopped, November 2008 (Read the announcement)Certification of Dracunculiasis Elimination: 2013

Since 1988, the Carter Center's Guinea Worm Eradication Program has worked with the Nigeria Federal Ministry of Health to spare thousands of people suffering from this devastating disease.

In collaboration with Nigeria's Federal Ministry of Health, the strategy for elimination consisted of several components, driven by health education. The goal was to change behavior and mobilize communities to improve the safety of their local water sources.

Approaches introduced to communities included health education and nylon filter distribution; treating stagnant ponds monthly with safe ABATE® larvicide (donated by BASF); voluntary isolation and care of patients in case containment centers; direct advocacy with water organizations; and increased efforts to build safer hand-dug wells. The program also trained and supervised village volunteers to carry out monthly surveillance and interventions.

In 2000, the government of Nigeria released more than 5 billion naira (approximately $50 million) for safe water to rural communities, with priority attention given to Guinea worm-endemic villages.

By November 2008, incidence of the disease had been reduced by more than 99 percent, with 38 indigenous cases reported, and all cases were contained. In December 2009, with 13 consecutive months of zero cases, Nigeria was provisionally determined to have broken Guinea worm transmission.

+Eliminating River Blindness

Nigeria is the most endemic country in the world for river blindness (onchocerciasis), accounting for as much as 40 percent of the global disease burden.

In 1989, its first year in operation, the Nigeria National Onchocerciasis Control Program treated 49,566 people with Mectizan® (ivermectin, donated by Merck). The Carter Center’s Nigeria River Blindness Elimination Program was launched in 1996, and has provided the largest number of Mectizan treatments of any Carter Center effort, cumulatively over 100 million. With headquarters in Jos, Plateau state and supporting sub-offices in Lagos, Owerri, Benin City, and Enugu, the Carter Center's River Blindness Elimination Program assists treatment activities in nine states in Nigeria: Abia, Anambra, Delta, Ebonyi, Edo, Enugu, Imo, Nasarawa, and Plateau.

In 2006 the Carter Center established an onchocerciasis and lymphatic filariasis molecular diagnostic laboratory at its Jos headquarters compound. The University of South Florida provides reference laboratory oversight for the state of the art laboratory.

In 2015 The Carter Center helped the Ministry of Health launch the Nigeria Onchocerciasis Elimination Committee. Four meetings have taken place so far, with participation of representatives from the Federal Ministry of Health, the World Health Organization, and the U.S. Centers for Disease Control and Prevention. This NOEC is making key recommendations to help accelerate elimination of river blindness from Nigera.

The same year, the Carter Center-assisted River Blindness Elimination Program in Nigeria distributed Mectizan and health education to over 9 million people across over 16,000 villages. Key partners include USAID/RTI/ENVISION and the Sir Emeka Offor Foundation.

The Carter Center piloted an integrated approach to target onchocerciasis, lymphatic filariasis, schistosomiasis, intestinal helminths, trachoma and malaria in Nigeria. Using the same program structure to provide medicine distribution and health education for more than one disease resulted in operational cost savings of approximately 41 percent over the stand-alone distributions.

+Eliminating Lymphatic Filariasis

Nigeria in 2017 announced it had eliminated lymphatic filariasis as a public health problem in two states in the center of the country.

Nigeria is the most endemic country for lymphatic filariasis in Africa, and the third most endemic country in the world, with about 66 percent of the Nigerian population at risk for the disease. In 1998, at the invitation of the Federal Ministry of Health and the state ministries of health of Plateau and Nasarawa states, The Carter Center helped the two states establish a Lymphatic Filariasis Elimination Program. The goal was to demonstrate that lymphatic filariasis transmission could be interrupted in one of the world's worst affected areas, and in so doing make the case for elimination from the rest of Africa. The World Health Organization verified in 2017 that the goal had been achieved.

In 2000, The Carter Center began supporting health education and annual mass treatments with the drugs Mectizan®(donated by Merck) and albendazole. These activities were extended statewide in 2003, using many of the same community volunteers and distribution system the Center helped pioneer for fighting river blindness. By 2009, lymphatic filariasis transmission had been halted in 10 of the 30 local government areas (LGAs) in the two states.

In Nigeria, lymphatic filariasis is transmitted by the same mosquito that transmits malaria. Long-lasting insecticidal nets (LLIN) are one of the most important prevention tools for malaria and are also believed to be helpful in eliminating lymphatic filariasis when used in conjunction with mass drug administration. Between 2009 and 2012, all nine Carter Center-assisted states in Nigeria received LLINs, donated through the Global Fund, with the aim of providing every household with two nets. These distributions totaled approximately 9.6 million LLIN.

In 2012, Nigeria announced that transmission of lymphatic filariasis had been stopped in Nasarawa and Plateau states. This announcement was made after transmission assessment surveys (TAS) were administered to confirm prevalence of the disease was low enough to ensure lymphatic filariasis could no longer be maintained. Community leaders, local ministry of health personnel, and community members played a crucial role in this pioneering campaign, in which more than 33 million drug treatments and millions of bed nets were distributed.

The Nigerian Federal Ministry of Health declared that mass drug administration for lymphatic filariasis could be stopped in Nasarawa and Plateau in 2013, and five years of post-treatment surveillance could begin. The program is currently conducting post-treatment surveillance TAS activities to determine whether the disease remains absent. Transmission assessment surveys in 2017 confirmed that the disease remains below sustainable levels in the two states.

With new support from the USAID/RTI/ENVISION project, the ministry of health, the Center, and other partners are expanding lymphatic filariasis elimination into seven states in Southeast and South South Nigeria, where The Carter Center and its partners integrated lymphatic filariasis, malaria, and schistosomiasis services. This program has experienced a rapid expansion, successfully reaching over 10 million treatments in its first year alone (2014), and achieved more than 18 million treatments in 2015.

In 2014, with support from The Carter Center and other partners, the Nigeria Federal Ministry of Health issued a detailed a set of co-implementation guidelines for its effort to eliminate malaria and lymphatic filariasis. The guidelines called for shared interventions such as health education, community based action, distribution of long-lasting insecticidal bed nets, and mass drug administration. These are the first of their kind in Africa.Learn more about the new guidelines >

+Controlling Trachoma

With support from the Conrad N. Hilton Foundation, The Carter Center and the Nigeria Federal Ministry of Health began working with state and local health authorities to implement trachoma control programs in Plateau and Nasarawa states in 2000. Since these states already supported Guinea worm eradication, lymphatic filariasis elimination, and control efforts for river blindness and schistosomiasis, the integration of trachoma control in these two states was a logical next step and began in 2003.

The Carter Center's Trachoma Control Program in Plateau and Nasarawa states in Nigeria focused on health education targeting those at highest risk of infection, primarily children and women in rural communities; promotion of household latrines to eliminate the breeding ground of eye-seeking flies; and mass distribution of antibiotics to treat active infections.

Health education activities are conducted through school-based programs, and mobilization for trachoma control is performed in communities, marketplaces, churches, and mosques. The national program uses television and radio as its mass media outlets. Health education and mobilization are conducted by trained community-based health workers including village volunteers. To increase the coverage of household sanitation, The Carter Center assisted the Ministry of Health to promote household latrine construction in rural communities.

In 2010, in partnership with the Ministry of Health and Sightsavers, the first mass treatment of blinding trachoma with azithromycin (Zithromax®, donated by Pfizer Inc.) was distributed in 10 local government areas in five states, two of which were Carter Center assisted (Plateau and Nasawara).

After three rounds of mass drug administration, in accordance with World Health Organization guidelines, community-based impact surveys were conducted in April and May 2014 in all accessible areas. The results of the surveys showed significant decreases in active trachoma from the baseline surveys conducted in 2007 and 2008. The Carter Center achieved its goal to significantly reduce active trachoma in Plateau and Nasarawa states. Due to this success, the Carter Center's Trachoma Control Program ended its assistance to the national program in both states in May 2015.

+Targeting Schistosomiasis

In partnership with Nigerian health authorities, the Carter Center's Schistosomiasis Control Program works to help control schistosomiasis in Delta, Ebonyi, Edo, Enugu, Nasarawa, and Plateau states, integrating the treatment of several diseases at once.

In this approach, health workers administer a combination of medicines simultaneously to treat river blindness, schistosomiasis, and several kinds of intestinal worms. Studies show that integrating treatment saves about 41 percent in operating costs.

Health education is a key element of the schistosomiasis effort. Because community life in Nigeria centers around local rivers and ponds, the program's main message is not to urinate or defecate in water and to take praziquantel during community drug distribution.

Through generous contributions of many additional partners, The Carter Center delivers schistosomiasis treatments that protect more than millions each year, mostly children, in program areas.

+Controlling Malaria

More deaths from malaria occur in Nigeria than in any other country; approximately one-third of the estimated 660,000 children who die annually from malaria worldwide are Nigerian.

In 2010, Nigeria launched the largest long-lasting insecticidal net distribution effort in history, with the goal of providing two nets to each household in the country. The Carter Center is a part of this epic activity, focusing efforts on the nine Nigerian states where The Carter Center has supported neglected disease control and elimination programs (lymphatic filariasis, river blindness, trachoma, and schistosomiasis). Since the same mosquito transmits both malaria and lymphatic filariasis in Africa, the distribution of bed nets — paired with health education — helps prevent both diseases at once.

In 2012, The Carter Center and its partners celebrated the distribution of 3.4 million of insecticide-treated bed nets for malaria control, the Center's largest amount in Nigeria to date. Previously, the Center had distributed more than 4.3 million bed nets in Nigeria from 2004 to 2011. As a result of the national program's dramatic scale-up, a Carter Center-supported survey found that the number of Nigerian households with at least two nets has increased from 34 percent in 2010 to 74 percent in 2012.

In addition, The Carter Center has developed and helped implement an innovative set of community-based interventions, including health education materials and continuous net distribution strategies, to increase and sustain the appropriate use of bed nets distributed to reduce transmission of both malaria and lymphatic filariasis.

With support from The Carter Center, the Nigeria Federal Ministry of Health recently issued a detailed set of co-implementation guidelines for a new effort to eliminate malaria and lymphatic filariasis. The first articulated guidelines of the kind in Africa, the plan takes advantage of shared interventions to tackle both diseases such as health education, distribution of long-lasting insecticidal bed nets, and mass drug administration. Learn more about the new guidelines.

+Increasing Food Production

Working hand in hand with Nigeria's Federal Ministry of Agriculture, The Carter Center, in partnership with the Sasakawa Africa Association, assisted Nigerian farmers in nine states with agricultural production starting in 1993. The program provided farmers with credit for fertilizers and enhanced seeds to grow test plots, which often yielded 200 to 400 percent more crops than more traditional methods. Participating farmers went on to teach others, creating a ripple effect to stimulate self-sufficiency.

The program was part of a larger partnership led by Nobel Peace Prize winner Dr. Norman Borlaug that helped over 8 million small-scale sub-Saharan African farmers in countries where malnutrition is a constant threat.

The Carter Center ended its agricultural activities in Nigeria in 2011.